When it comes to preventing Alzheimer's, women respond better than men


Date:
April 26, 2022
Source:
Florida Atlantic University
Summary:
A study is the first to examine if sex significantly affects
cognitive outcomes in people who follow individually-tailored,
multi-domain clinical interventions. The study also determined
whether change in risk of developing cardiovascular disease
(CVD) and Alzheimer's disease (AD), along with blood markers of
AD risk, also were affected by sex. Results showed that while
care in an Alzheimer's Prevention Clinic setting is equally
effective at improving cognitive function in both women and men,
the personally-tailored interventions used by the researchers led
to greater improvements in women compared to men across AD and CVD
disease risk scales, as well blood biomarkers of risk such as blood
sugar, LDL cholesterol, and the diabetes test HbA1C. Findings are
important because women are disproportionately affected by AD and
population-attributable risk models suggest that managing risk
factors can prevent up to one- third of dementia cases.



FULL STORY ========================================================================== After increasing age, the most significant risk factor for Alzheimer's
disease (AD) is sex -- two-thirds of patients with AD are females. In
fact, even when accounting for gender-dependent mortality rates, age
at death, and differences in lifespan, women still have twice the risk
of incidence.


==========================================================================
A study headed by Florida Atlantic University's Richard S. Isaacson,
M.D., a leading neurologist and researcher, and collaborators from
NewYork- Presbyterian/Weill Cornell Medicine, is the first to examine
if sex significantly affects cognitive outcomes in people who follow individually- tailored, multi-domain clinical interventions. The study
also determined whether change in risk of developing cardiovascular
disease and AD, along with blood markers of AD risk, also were
affected by sex. Other studies have focused on the role of hormones
and sex-specific risk factors when examining differences in AD risk,
but none have explored if these interventions result in differences in real-world clinical practice.

The study is an analysis of the Comparative Effectiveness Dementia
& Alzheimer's Registry (CEDAR) trial launched at Weill Medicine in
2015 and spearheaded by Isaacson, which has already demonstrated that individualized, multi-domain interventions improved cognition and reduced
the risk of AD in both women and men.

In the sub-group analysis, researchers evaluated the differential
effectiveness of the clinical approach itself when considering sex in higher-compliance participants (n=80) from the original study cohort
(n=154). Within this cohort, similar to the original study, participants
were categorized by baseline diagnoses: normal cognition, subjective
cognitive decline, and preclinical AD participants were classified as "Prevention." Mild cognitive impairment due to AD and mild AD were
classified as "Early Treatment." Results of the study, published in the Journal of Prevention of Alzheimer's Disease, showed that risk reduction
care in an Alzheimer's Prevention Clinic setting led to improvements
in cognition in both women and men without sex- differences. However,
in the Prevention group, women demonstrated greater improvements in the Multi-Ethnic Study of Atherosclerosis risk score (MESA) than men. Women
in the Early Treatment group also demonstrated greater improvements in CV
Risk Factors, Aging and Incidence of Dementia (CAIDE) risk score and the MESA-RS. The CAIDE is a validated risk index that calculates late-life
dementia risk based on midlife vascular risk factors such as body mass
index, blood pressure, cholesterol and smoking status, while the MESA
estimates one's risk of cardiovascular disease incidence over the next
ten years using traditional risk factors.

"While care in an Alzheimer's Prevention Clinic setting is equally
effective at improving cognitive function in both women and men, our personally-tailored interventions led to greater improvements in women
compared to men across Alzheimer's and cardiovascular disease risk scales,
as well blood biomarkers of risk such as blood sugar, LDL cholesterol,
and the diabetes test HbA1C," said Isaacson, lead author and director
of the newly launched FAU Center for Brain Health and the Alzheimer's Prevention Clinic within the Schmidt College of Medicine, who conducted
the study while at Weill Cornell Medicine and NewYork- Presbyterian. "Our findings are important because women are disproportionately affected
by Alzheimer's disease and population-attributable risk models suggest
that managing risk factors can prevent up to one-third of dementia cases, highlighting the immense potential that lies in addressing modifiable risk factors." After undergoing baseline clinical assessments, which included
a detailed clinical history, physical examination, anthropometrics,
blood biomarkers, apolipoprotein-?4 (APOE-e4) genotyping, and cognitive assessment, patients in the CEDAR study were given individually-tailored, multi-domain intervention recommendations informed by these clinical
and biomarker data. Recommendation categories included patient education/genetic counseling, individualized pharmacological approaches (medications/vitamins/supplements), non- pharmacological approaches
(exercise counseling, dietary counseling, vascular risk reduction, sleep hygiene, cognitive engagement, stress reduction, and general medical care)
and other evidence-based interventions.

"Our latest results suggest that the individualized management approach
used by the CEDAR study in a real-world clinic may offer equal cognitive benefits to both women and men, as well as better mitigation of calculated Alzheimer's disease and cardiovascular disease risk in women compared to
men," said Isaacson. "Our work also highlights the need for larger studies focusing on sex differences in AD-related cognitive trajectories, as the existing body of knowledge lacks conclusive evidence on this issue."
Isaacson and collaborators are planning on larger cohorts to further
define sex differences in AD risk reduction in clinical practice and hope
to launch a multi-site international study soon to draw more definitive conclusions.

Collaborators of the study include FAU's Schmidt College of Medicine;
Cleveland Clinic; Lou Ruvo Center for Brain Health, Las Vegas;
Jersey Memory Assessment Service, Jersey, United Kingdom; Alzheimer's Prevention Clinic & Research Center of Puerto Rico, San Juan; Weill
Cornell Medicine & NewYork-Presbyterian; New York; Norton Neuroscience Institute, Louisville; McGill University Faculty of Medicine, Montreal,
Canada; University of New South Wales/University of Notre Dame, Sydney, Australia; and Atria Institute, New York.

The study was primarily supported by the Women's Alzheimer's Movement
with additional support from the Altman Family Fund, Zuckerman Family Foundation Ace's for Alzheimer's, the Harry T. Mangurian, Jr. Foundation, philanthropic support from the patients of the Alzheimer's Prevention
Clinic at Weill Cornell Medicine, the National Institutes of Health
(NIH), and the National Center for Advancing Translational Research (UL1TR002384) and NIH (PO1AG026572).


========================================================================== Story Source: Materials provided by Florida_Atlantic_University. Original written by Gisele Galoustian. Note: Content may be edited for style
and length.


========================================================================== Journal Reference:
1. N. Saif, H. Hristov, K. Akiyoshi, K. Niotis, I.E. Ariza,
N. Malviya, P.

Lee, J. Melendez, G. Sadek, K. Hackett, A. Rahman,
J. Mele'ndez-Cabrero, C.E. Greer, L. Mosconi, R. Krikorian,
R.S. Isaacson. Sex-Driven Differences in the Effectiveness
of Individualized Clinical Management of Alzheimer's Disease
Risk. The Journal Of Prevention of Alzheimer's Disease, 2022;
DOI: 10.14283/jpad.2022.44 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/04/220426101641.htm

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